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HEALTH  CONDITIONS  IN  THE  CANAL  ZONE 


BY 


COL.  W.  C.  GOKGAS,  U.  S.  A. 

Chief  Sanitary  Officer 
CANAL  ZONE 


Twenty-four  years  ago  the  great  French  company 
financed  by  M.  de  Lesseps  began  work  on  the  Panama 
Canal,  under  circumstances  similar  to  those  that  have 
confronted  ns.  The  only  difference  is  that  they  took  no 
sanitary  precautions  whatever  in  connection  with  their 
work;  and  if  we  had  followed  their  example,  conditions 
on  the  isthmus  would  probably  be  now  what  those  of  the 
French  were,  at  the  same  length  of  time  after  they  began 
their  work. 

The  United  States  has  had  control  of  the  canal  for  a 
little  over  one  year.  If,  therefore,  we  consider  what  the 
sanitary  conditions  among  the  French  workers  were  at 
the  end  of  their  first  year,  the  comparison  with  our 
present  state  will  be  a fair  one.  I have  no  intention  of 
criticising  the  French.  If  we  had  come  down  here 
twenty-four  years  ago,  situated  as  they  were,  I am  not 
sure  that  we  could  have  done  very  much  better.  In  the 
first  place,  no  one  knew  at  that  time  how  malaria  or 
yellow  fever  was  conveyed  from  one  person  to  another; 
and  in  the  second  place,  the  French  were  building  the 
canal  just  as  we  build  a railroad  in  the  United  States. 
They  were  a private  corporation,  and  could  not  control 
the  sanitary  arrangements  along  their  route — a matter 
which  was  entirely  in  the  hands  of  the  Colombian 
government. 


Now  let  us  see  what  the  conditions  of  the  French  were 
as  to  health  at  the  end  of  their  first  year.  I think  prob- 
ably the  best  measure  that  I can  take  of  this  condition  is 
their  death-rate.  The  report  of  the  old  French  company 
for  the  year  1881  shows  that  they  had,  on  an  average, 
UP®,  928  employees  per  day  at  work ; of  this  number  630  per 
1,000  were  taken  sick,  and  67  per  1,000  died;  but  the 


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French  records  are  known  to  be  very  inaccurate;  the 
actual  state  of  affairs  was  much  worse  than  their  reports 
show. 

The  canal  was  divided  into  sections,  and  the  construc- 
tion work  on  these  sections  wras  let  out  by  contract.  The 
contractors  were  charged  $1  a day  for  every  one  of 
their  employees  who  went  to  the  hospital.  The  tendency, 
was,  therefore,  to  discharge  a man  as  soon  as  he  became 
sick,  so  that  he  would  not  be  a charge  against  the  con- 
tractor, and  no  one  not  actually  in  the  employment  of 
the  company  itself,  or  of  the  contractors,  was  received 
into  the  hospitals.  The  probability  would  be,  therefore, 
that  deaths  would  occur  not  among  those  actually 
employed,  but  at  the  villages  along  the  line  of  the  canal, 
among  the  men  who  had  been  discharged  by  the  con- 
tractors. And  this  is  the  opinion  in  Panama  among 
the  people  who  were  here  at  the  time  of  the  French  con- 
struction, namely,  that  many  deaths  occurred  along  the 
line,  of  which  the  French  authorities  have  no  record. 
Now  when  the  French  sanitary  officer  reports  that  67 
men  per  1,000  of  the  French  employees  in  the  year  1881 
died,  he  means  that,  on  the  average,  they  had  at  work 
every  day  928  men  along  the  whole  line  of  the  canal,  and 
that  67  per  1,000  of  this  number  died  in  hospital  in  the 
course  of  the  year.  He  only  knows,  and  takes  account 
of  the  men  who  died  in  their  hospital.  He  knows  noth- 
ing of  any  man  who  was  discharged  by  the  contractor  at 
Culebra,  say,  on  account  of  being  sick,  and  died  a week 
or  ten  days  afterward  in  the  village  of  Culebra. 

Personally,  I think  it  would  not  be  unfair  to  say  that 
instead  of  losing  67  per  1,000,  they  lost  considerably 
more  than  100  per  1,000,  but  this  is  mere  guess  and 
supposition.  I only  know  that  they  lost  more  than  67 
per  1,000;  how  many  more  it  is  impossible  to  say. 

Now  let  us  .turn  our  health  conditions  at  the  end  of 
a year,  measured  by  the  same  standard.  I will  take  the 
month  of  March,  as  that  is  the  last  month  of  which 
I have  a report.  I cannot  compare  the  whole  year,  as 
the  figures  for  such  comparison  have  not  yet  been  col- 
lected ; but  I am  quite  certain  that  March  wras  an  average 
month,  and  that  the  comparison  is  fair.  We  had  on  the 
rolls  at  the  end  of  the  month  9,000  men,  and  of  these 
401  per  1,000  a year  were  taken  sick,  and  14.66  per 
1,000  a year  died.  I mean  by  this  that  the  rate  of  sick- 
ness and  death  which  we  had  during  March,  if  extended 


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over  the  whole  year,  and  applied  to  an  average  of  9,000 
men,  would  have  given  us  this  rate  of  sickness  and  death. 

Our  report  includes  everything.  When  we  say  14.66 
of  our  laborers  per  1,000  have  died,  it  means  that  every 
man  in  the  employment  of  the  Commission  at  the  isthmus 
is  counted,  and  every  one  of  these  men  who  dies,  if  he 
was  an  employee  of  the  Commission  at  the  time  he  was 
taken  sick,  is  also  considered.  The  Commission  cares 
for  all  its  employees  free  of  charge,  so  that  all  employees 
who  are  sick  come  to  the  hospitals;  and,  besides,  the 
Sanitary  Department  has  control  of  the  towns  of  Colon 
and  Panama,  and  the  intervening  country  along  the 
canal;  and  it  has  accurate  records  of  all  the  deaths  occur- 
ring in  these  regions.  Therefore,  when  we  say  that  14 
per  1,000  died,  the  statement  is  accurate  and  compre- 
hensive. 

I think  it  is  fair  then  to  make  this  summary  : that, 
taking  March  as  an  average,  both  in  numbers  of  men 
and  in  mortality,  we  have  lost  by  death  during  the  first 
year  of  our  work  14.66  per  1,000  of  our  men  (which  for 
9,000  men,  would  mean  132  deaths)  ; and  we  have  sick- 
ness to  the  extent  of  401  per  1,000,  which,  for  the  whole 
force,  would  give  3,605  sick.  Taking  the  French  mor- 
tality for  their  first  year,  as.  showing  what  would  have 
occurred  with  no  sanitary  precautions,  we  would  have 
had,  instead  of  132  deaths,  620  deaths ; instead  of  3,605 
sick,  5,850  sick.  Now  this^  it  seems  to  me,  clearly  means 
that  our  sanitary  work  for  this  first  year  has  saved  488 
lives  and  2,238  cases  of  sickness. 

Now,  as  to  the  measures  that  we  claim  to  have  been 
instrumental  in  this  saving  of  human  life,  on  the 
isthmus  we  find,  from  reading  of  the  experiences  of  our 
predecessors,  that  the  two  principal  diseases  to  be  feared 
are  malaria  and  yellow  fever;  our  measures,  therefore, 
have  been  directed  against  these  diseases.  The  authori- 
ties of  the  Panama  Republic  placed  the  sanitation  of  the 
towns  of  Colon  and  Panama  in  our  charge.  We  have 
established  health  departments  in  these  towns,  cleaned 
the  streets,  collected  the  garbage,  ditched  and  oiled  all 
the  districts  possible,  for  the  destruction  of  mosquitoes, 
covered  all  fresh-water  receptacles  in  the  city  of  Panama, 
and  fumigated  the  whole  town  from  one  end  to  the  other 
for  the  destruction  of  infected  mosquitoes. 

At  this  writing,  April  18,  we  have  not  a single  case  of 
yellow  fever  in  the  city  of  Panama,  the  last  case  having 


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occurred  March  23;  and  while  it  is  premature  to  make 
any  statement  yet  with  regard  to  the  extermination  of 
yellow  fever,  I personally  believe  that  we  have  seen  the 
last  case  of  yellow  fever  in  Panama. 

We  have  established  health  departments  in  all  the 
towns  extending  along  the  fifty  miles  of  canal  route 
between  Colon  and  Panama,  ditched  and  drained  all 
low  ground  in  the  neighborhood  of  these  villages,  cut 
away  all  the  undergrowth  in  and  about  the  villages  and 
in  the  neighborhood  of  all  dwellings  and  buildings, 
cleaned  up  the  villages,  and  inaugurated  systems  of  gar- 
bage disposal. 

We  have  also  established  a very  good  quarantine  sys- 
tem, by  the  aid  of  which  I feel  confident  that  all  foreign 
infection  will  be  prevented  from  entering.  We  have  also 
established  an  immigration  bureau,  with  the  idea  of 
examining  all  arriving  laborers,  seeing  that  they  are 
vaccinated,  and  deporting  such  as  are  likely  to  be  a 
charge  upon  the  Commission. 

We  have  a system  of  hospitals  for  the  care  of  the 
employees  of  the  Commission,  and  for  any  cases  of  dis- 
ease that  may  be  infectious,  even  though  it  may  be  among 
the  population  not  employed  by  the  Commission.  In 
these  hospitals  we  are  at  present  treating  about  300 
patients. 

We  have  established  a laboratory  for  the  investigation 
of  diseases  in  connection  with  our  hospital  work.  In 
doing  all  this  sanitary  work  we  have  on  our  rolls  at 
present  considerably  over  a thousand  men. 

The  results  accomplished  so  far  have  been  that  our 
laboring  force  has  -been  kept  in  about  as  good  a state 
of  health  as  a similar  number  of  men  in  any  healthy  part 
of  the  United  States  would  have  been.  This,  I think, 
judging  by  the  light  of  past  experiences,  is  a very  great 
accomplishment  and  fully  justifies  the  expenditure  so 
far  made  on  sanitation  at  Panama.  As  I have  already 
stated,  our  death  rate  among  9,000  laborers  along  the 
canal  for  the  month  of  March  was  at  the  rate  of  14.66 
per  1,000  per  year — that  is,  if  the  rate  of  March  was 
kept  up  for  a year,  we  would  lose  by  death  fourteen  out 
of  every  1,000.  Hew  York  City  for  the  year  1900  had  a 
death-rate  of  20  per  1,000,  Philadelphia  21,  Washington 
22.  This  means  that  in  Hew  York  City,  in  the  year 
1900,  out  of  every  1,000  people  twenty  died;  in  Phila- 
delphia, twenty-one  died,  and  in  Washington,  twenty- 


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two  died;  but  among  the  laborers  on  the  isthmus  only 
14  per  1,000  died  in  our  first  year  of  work,  extending 
from  May,  1904,  to  May,  1905.  If  we  select  at  random 
a thousand  people  in  Philadelphia  and  a thousand  of 
our  laborers  on  the  isthmus,  the  thousand  people  in  Phila- 
delphia would  lose  by  death  six  more  in  the  course  of  a 
year  than  the  thousand  laborers  on  the  canal ; a thousand 
people  in  Washington  eight  more  than  a thousand  labor- 
ers on  the  canal.  I do  not  pretend  that  this  is  a just 
comparison;  Philadelphia  and  Washington  have  a large 
population  of  children,  while  the  laborers  are  all  adults, 
mostly  in  the  prime  of  life,  but  it  conveys  some  idea  of 
what  has  been  accomplished  in  the  way  of  improving 
health  conditions. 

We  expect  to  continue  our  work  along  the  lines  which 
I have  described.  Within  the  next  year,  for  instance, 
we  expect  to  provide  Panama  with  a good  water-supply, 
a good  sewerage  system,  and  good  pavements;  in  other 
words,  the  work  of  the  Sanitary  Department  will  be 
perfected  in  every  direction.  In  Colon  we  expect  to 
have  the  whole  island  filled  in  with  material  dredged 
from  the  canal,  so  that  instead  of  being  a swamp  it  will 
be  12  or  15  feet  above  the  water  level.  We  expect  to 
have  the  streets  paved,  a good  water-supply  brought  in 
from  the  country,  and  a sewerage  system  installed.  All 
these  projects  are  now  under  way.  Along  the  line  we 
expect  to  continue  our  mosquito  work,  continue  the 
organization  of  the  local  health  departments,  place  water 
and  sewerage  systems  in  several  of  the  larger  towns,  and 
have  systems  of  disposal  of  night-soil  established  in  all 
the  others. 

We  have  been  authorized  by  the  Commission  to 
increase  the  hospital  accommodations  to  a thousand  beds. 
To  do  this  we  need  a considerable  amount  of  construc- 
tion, which  we  expect  to  have  finished  within  the  coming 
year.  We  expect  to  establish  small  receiving  hospitals 
and  dispensaries  at  all  the  villages  along  the  line,  both 
for  treating  the  sick,  and  for  keeping  a close  sanitary 
supervision  of  diseases  occurring  in  the  strip.  We  expect 
to  improve  our  quarantine  department  in  the  way  of 
buildings  for  the  purpose  of  housing  people  under  obser- 
vation and  looking  after  laborers  and  immigrants  until 
they  can  be  properly  distributed,  and  conveniences  gen- 
erally for  carrying  on  this  work. 

Now  a word  about  yellow  fever.  It  is  too  early  to  make 
any  positive  statement  to  the  effect  that  we  have  elimi- 


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nated  the  disease,  but  I believe,  nevertheless,  that  we 
have,  for  this  reason:  The  town  of  Panama  was  pretty 
generally  infected;  yellow  fever  was  occurring  in  every 
part.  The  number  of  non-immunes  here,  the  only  people 
liable  to  yellow  fever,  has  been  steadily  increasing;  yet 
on  adopting  the  measures  we  used  in  Havana, . Cuba,  the 
same  results  have  apparently  occurred. 

In  the  city  of  Panama  during  the  month  of  January 
we  had  9 cases ; in  February,  13 ; in  March,  7 ; and  none, 
so  far,  in  April;  the  last  case  occurred  March  23.  The 
measures  adopted,  which  were  the  same  as  those  used 
in  Havana,  resulted  from  the  discovery  that  the  disease 
was  transmitted  by  the  female  stegomyia  mosquito. 

* Every  house  in  Panama  has  been  carefully  closed  and 
fumigated  so  as  to  kill  every  mosquito  inhabiting  it,  the 
idea  being  to  kill  all  the  infected  mosquitoes.  At  the 
same  time,  all  cases  of  yellow  fever  as  they  occurred  were 
carefully  screened  so  that  mosquitoes  could  not  get  at 
them  and  thus  reinfect  the  town. 

It  is  not  a very  difficult  thing  to  keep  yellow  fever  out, 
and  I feel  entirely  confident  that  our  present  quarantine 
service  will  succeed  in  doing  so.  In  Havana  they  have 
been  free  of  it  since  1901. 

About  malaria  I cannot  speak  so  positively  ; but  our 
experience,  so  far  as  to  the  effect  mosquito  extermination 
has  on  decreasing  the  disease  here  at  Panama,  is  very 
much  the  same  as  it  was  at  Havana,  and  I feel  greatly 
encouraged  at  the  outlook. 


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